General practice crisis threatens future of wider NHS, leading GPs warn

The whole NHS is on the verge of failing unless urgent action is taken to avert the crisis facing general practice, leading GPs have warned.

Sir Sam Everington: warning over future of NHS
Sir Sam Everington: warning over future of NHS

GP and Cambridge researcher Professor Martin Roland - an architect of the QOF who recently led a major GP workforce commission - and Tower Hamlets CCG chairman Sir Sam Everington issued a stark warning on the NHS' future if urgent action is not taken to rescue general practice.

In a letter published in the BMJ, they call for GPs to be given a rescue package of funding – similar to one totalling £500m given to emergency departments in 2013 – and for the 25-year-old Carr-Hill formula to be replaced by a new, fairer funding formula.

NHS England should also extend crown indemnity to the profession to tackle spiralling indemnity costs, while the current £224m CQC inspection regime should be significantly scaled back to look at ‘perhaps only the 5-10% of practices found to be struggling’. These calls echo demands backed by GPs at the special LMCs conference on the GP crisis earlier this year.

In the longer term, the relationship between GPs and specialists should be improved and payment-by-results funding for hospitals should be replaced with a population-based, capitated budget to better incentivise hospitals to support patients and clinicians in the community, they argue.

GP crisis

Hospitals’ financial problems often make front-page news, they said, with ‘dramatic’ headlines such as ‘hospitals facing £2bn funding deficit’ – but they cannot go bust because ‘someone always picks up the bill’.

But general practice, they add, ‘doesn’t have that luxury’ – and its share of the NHS budget has fallen progressively from a high of 11% in 2006 to under 8.5% now.

At the same time, GP workload has soared, with GPs now completing 370m consultations a year – 60m more than five years ago.

This is coupled with ‘overwhelming regulatory burdens’, piling pressure on GPs and causing the profession’s confidence in its sustainability to fall ‘critically low’.

‘GPs currently manage the great majority of patients without referral or admission to hospital,’ they warned. ‘If the current strain on general practice were to shift this balance only slightly, hospitals would be overwhelmed.

‘It is general practice that makes the NHS one of the world’s most cost effective health services – the £136 per patient per year for unlimited general practice care is less than the cost of a single visit to a hospital outpatient department.

Primary care funding

‘Primary care needs fair funding to deliver on the NHS’s ambitious plans, and GPs need to feel valued rather than continually criticised by politicians and regulators.

‘Urgent action is needed to restore the NHS. But the crisis will not be averted by focusing on hospitals. If general practice fails, the whole NHS fails.’

Professor Roland added: ‘Many other countries see primary care as the jewel in the crown of the NHS, yet many practices are at breaking point, with an increasing number simply handing in their contracts and closing.’

Sir Sam said: ‘Patients really value the support of their family doctor, particularly in crises like end-of-life care. Moving care into the community means supporting patients to die at home surrounded by their loved ones – this is one of many reasons why family medicine is critical to the NHS.’

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